Aggressive fluid accumulation is associated with acute kidney injury and mortality in a cohort of patients with severe pneumonia caused by influenza A H1N1 virus

Abstract

IntroductionFluid accumulation is associated with adverse outcomes such as acute kidney injury (AKI) in critically ill patients. This study aimed to describe the factors associated with AKI in individuals with influenza A H1N1 severe pneumonia, and explore the relation of fluid accumulation with AKI and mortality.Material and methodsWe reviewed medical records of individuals with influenza A H1N1 severe pneumonia and no history of chronic kidney disease, attending a national referral center for respiratory diseases between November 2014 and May 2015. Demographic information, risk factors for AKI, physiologic and laboratory data, outcomes and information on fluid intake and output were recorded. Categorical variables were compared using the chi-square test. Quantitative variables were compared using the Mann-Whitney test. Factors associated with AKI and mortality were identified by binary logistic regression. Linear models of fluid accumulation rates for individuals and groups were estimated using segmented linear regression.ResultsOf 60 patients studied, 43 developed AKI (71.6%). Male gender was protective for AKI (p = 0.019). AKI was associated with nephrotoxic drugs (p = 0.016); PEEP>10 cm H2O on admission (p = 0.031); mortality (p = 0.037); and fluid accumulation ≥10% (fluid overload) at day 7 of hospitalization (p = 0.00026). Mortality was associated with older age (p = 0.009); nephrotoxic drugs (p = 0.034); and higher Pneumonia Severity Index score (112 vs. 76, p = 0.008) on admission. The Deceased-AKI group had a higher rate of fluid accumulation (expressed as ml/kg/body weight) than the Survivors-No AKI group during the study period of 7 days (Survivors-No AKI = 13.31 vs. Deceased-AKI = 22.76, p = 0.019). During the highest phase of fluid accumulation, the Survivors-No AKI group had a slower rate of fluid accumulation than the Survivors-AKI group (14.91 vs. 28.49, p = 0.001).ConclusionsA high rate of fluid accumulation was associated with AKI and mortality. We support the approach of resuscitation in acute illness, with an early transition to neutral and then negative fluid balances.

Tissue-resident CD8+T cells drive age-associated chronic lung sequelae following viral pneumonia

“…Among respiratory viral pathogens, influenza virus can infect 5–10% of the population [15], resulting in up to 35.6 million illnesses and 56,000 deaths annually in the U.S. alone since 2010 [16]. For reasons that are still not fully defined, many respiratory viruses including SARS-CoV-2 and influenza virus cause disproportionately severe morbidity in the elderly population [17, 18]. For instance, the vast majority of the mortality associated with both influenza and SARS-CoV-2 infections, occur in people 65 years and older.…”

Outcome of Critically Ill Patients With Influenza Infection: A Retrospective Study

“…30 Several studies have described the same association with influenza, especially ARDS-related influenza A H1N1 during the 2009 pandemic. [31][32][33] Acute tubular necrosis seems to be the main pathological finding in an autopsy series of patients with AKI who died in the 2009 pandemic. 34 Pathophysiology is poorly understood, but AKI is probably multifactorial involving renal hypoperfusion, hypoxia, rhabdomyolysis, vasoconstriction, and SIRS (systemic inflammatory response syndrome).…”

Mechanistic Aspects and Therapeutic Potential of Quercetin against COVID-19-Associated Acute Kidney Injury

“…Therefore, avoiding or even controlling the progression of AKI during viral infection have become challenges for the medical community. Various kidney diseases are associated with viral infections, including infection caused by the HIV virus [57], Epstein-Barr virus [58], parvovirus B19 [59], hepatitis B virus (HBV) [60], hepatitis C virus (HCV) [61], Zika virus [62], dengue virus [63], and influenza A (H1N1) virus [64]. A large spectrum of prevalence and clinical manifestations are observed among viral diseases, ranging from mild and rare AKI caused by acute symptomatic Epstein-Barr virus infectious mononucleosis [58] to rapid deterioration of renal function, often resulting in the requirement of renal replacement therapy, as observed in hantavirus-type infection [51,58,65,66].…”